SEMSEC 2009 Online Membership Form

I would like to apply for membership of the South East Motor Sports Enthusiasts Club.

Payment is taken by PayPal. You do not need a PayPal account.

Name:
Address:

Postcode:

Email Address:

Telephone:
TYPE OF MEMBERSHIP / MEMBERSHIP FEES (per annum)
Joint Racing Membership & Registration – Closed Wheel Series £ 65.00 *
Joint Racing Membership & Registration – Single Seater Championship £ 60.00
If applying for more than one championship/challenge registration an additional fee of £15 per championship/challenge is payable.  
Multiple championship/challenge registration fee £ 25.00 (1 extra) £ 50.00 (2 extra)
Racing Membership £ 45.00
Standard Full Membership £ 15.00
Membership for Marshals FREE**
Associate Membership FREE***
TOTAL
£
* If applying for Joint Racing Membership and Championship/Challenge please complete the boxes below:
** Marshals/Officials membership is available to anyone who marshalled or officiated at a SEMSEC event in 2009.
*** If applying for associate membership please enter which club with whom you are currently a fully paid up member and complete the details in the box below. Associate membership is only available to fully paid up members of the Tunbridge Wells Motor Club or Rochester Motor Club.
Club:  Membership No.  Expiry Date:
JOINT RACING MEMBERSHIP AND CHAMPIONSHIP/CHALLENGE DETAILS:
Championship/Challenge(s) registrations applied for: Class in which to be registered:
1, 1,
2, 2,
3, 3,
DETAILS OF CAR TO BE USED:
Make  Model  CC: Forced Injection: Yes  No
Preferred Competition Number:  Transponder Number:  MSA Licence Number:  Licence Grade:
Yes  No Steel Bodied Entrant's Name
Yes  No Forced Induction Entrant's MSA Licence Number:
Yes  No Roadgoing

Entrant's Address:
Sports Racing
Special Saloon/Sports Car
Seven Type or Kit Car
Production Sports Car
Intermediate Saloon or Sports

Enter the code shown above in the box below.